Sanctifi Health — Acuerdo Financiero y Política de Pago

Last updated: April 1, 2025

Sanctifi Health PC — Financial Agreement and Payment Policy

Effective Date: April 1, 2025

Introduction

This Financial Agreement and Payment Policy ("Agreement") establishes the financial terms and conditions between you ("Patient," "you," or "your") and Sanctifi Health PC, its healthcare providers, employees, contractors, and agents (collectively, "Sanctifi Health," "we," "us," or "our").

PLEASE READ THIS DOCUMENT CAREFULLY BEFORE AGREEING. By checking the "I Agree" box, clicking "Accept," or otherwise indicating your acceptance, you acknowledge that you have read, understood, and agree to all financial terms and conditions outlined herein.

1. Cash-Pay Model

1.1 Cash-Pay Only Practice

Sanctifi Health PC operates exclusively as a cash-pay medical practice. This means:

  • We do NOT accept any form of health insurance, including private insurance, Medicare, Medicaid, TRICARE, or any other government or private health insurance programs.
  • We do NOT submit claims to insurance companies on your behalf.
  • We do NOT participate in any insurance networks or provider panels.

1.2 Insurance Opt-Out Status

You understand and acknowledge that:

  • Our healthcare providers have opted out of Medicare and other insurance programs.
  • You cannot submit claims to Medicare for reimbursement for services received from Sanctifi Health PC.
  • If you are a Medicare beneficiary, you will be required to sign a separate Medicare Private Contract acknowledging your understanding of these limitations.

1.3 No Insurance Billing or Coordination

You understand and acknowledge that:

  • You are solely responsible for paying the full cost of all services at the time they are rendered.
  • We will not assist with insurance claims or reimbursement beyond providing you with an itemized receipt of services.
  • If you choose to seek reimbursement from your insurance company, you do so independently and at your own risk, with no guarantee of reimbursement.

2. Payment Terms

2.1 Payment Responsibility

You agree that you are financially responsible for all charges related to services provided by Sanctifi Health PC, including:

  • Telehealth consultations
  • Follow-up appointments
  • Medication management
  • Administrative fees
  • Any other services provided by Sanctifi Health PC

2.2 Payment Methods

We accept the following payment methods:

  • Credit cards (Visa, MasterCard, American Express, Discover)
  • Debit cards
  • Health Savings Accounts (HSA)
  • Flexible Spending Accounts (FSA)
  • Other electronic payment methods as specified on our website

We do NOT accept cash, checks, money orders, or cryptocurrency payments.

2.3 Payment Timing

Payment is required at the time services are rendered:

  • For scheduled appointments: Payment will be collected at the time of booking or immediately before your appointment.
  • For medication prescriptions: Payment for any applicable prescription fees must be made before medications are prescribed.
  • For recurring services: You may be offered the option to authorize automatic recurring payments.

2.4 Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA)

You understand and acknowledge that:

  • While we accept HSA and FSA cards as payment methods, we cannot guarantee that our services will qualify as eligible expenses under your specific HSA or FSA plan.
  • It is your responsibility to verify whether our services qualify as eligible expenses under your HSA or FSA plan before using these payment methods.
  • We are not responsible for any tax consequences or penalties that may result from using HSA or FSA funds for services that may not qualify as eligible expenses.

3. Fee Schedule

3.1 Transparency in Pricing

Our current fee schedule is posted on our website and available upon request. Applicable fees are disclosed before services are rendered.

3.2 Fee Schedule Changes

You understand and acknowledge that:

  • Our fee schedule is subject to change without notice.
  • The most current fee schedule is always available on our website or upon request.
  • You will be informed of the applicable fees before services are rendered.

4. Refund Policy

4.1 No-Refund Policy

Sanctifi Health PC maintains a strict no-refund policy for all services rendered. You understand and acknowledge that:

  • All payments made to Sanctifi Health PC are final and non-refundable.
  • This includes payments for consultations, medication management, administrative services, and any other services provided.
  • There are no exceptions to this policy, regardless of:
    • Your satisfaction with the services
    • Whether your desired medication was prescribed
    • Technical difficulties during telehealth sessions
    • Changes in your medical condition or needs
    • Any other circumstances

4.2 Service Guarantee

While we maintain a no-refund policy, we are committed to providing high-quality care. If you experience technical difficulties during a telehealth session that are caused by our systems, we will reschedule your appointment at no additional charge. This does not constitute a refund but rather the completion of the service for which you have paid.

5. Cancellation and Missed Appointment Policy

5.1 Cancellation Timeframe

You must cancel or reschedule your appointment within the timeframe specified on our website or in your appointment confirmation to avoid a missed appointment fee.

5.2 Missed Appointment Fee

If you fail to attend your scheduled appointment or cancel/reschedule with less than the required notice, a missed appointment fee will be charged to your payment method on file. The current fee amount is disclosed at the time of booking and on our website.

5.3 No-Show Policy

After three (3) missed appointments without proper notice, Sanctifi Health PC reserves the right to discontinue providing services to you.

6. Third-Party Payment Platforms

6.1 Third-Party Payment Processing

You understand and acknowledge that:

  • We may use third-party payment processors to handle financial transactions.
  • These processors have their own terms of service and privacy policies.
  • Your payment information will be subject to the terms and privacy policies of these third-party processors.

6.2 Authorization for Charges

By providing your payment information and agreeing to this Financial Agreement, you authorize Sanctifi Health PC and its payment processors to charge your payment method for all services rendered, in accordance with our fee schedule and policies.

7. Financial Records and Receipts

7.1 Itemized Receipts

You will receive an itemized receipt for all services rendered, which will include:

  • Date of service
  • Type of service
  • Provider name
  • Amount paid
  • Any applicable diagnosis codes (upon request)
  • Any applicable procedure codes (upon request)

7.2 Super Bill Requests

Upon request, we can provide a "super bill" that you may submit to your insurance company for potential reimbursement. However:

  • We make no guarantees regarding insurance reimbursement.
  • We do not assist with the insurance submission process.
  • We are not responsible for denied claims or partial reimbursements.

8. Financial Hardship

Sanctifi Health PC does not offer sliding scale fees, payment plans, or financial assistance programs. All patients are subject to the same fee schedule regardless of financial situation.

9. Termination of Care for Financial Reasons

9.1 Non-Payment

Sanctifi Health PC reserves the right to discontinue providing services if payment is not received at the time of service.

9.2 Payment Disputes

In the event of a payment dispute, such as a chargeback or payment reversal:

  • We reserve the right to immediately discontinue providing services.
  • We may pursue all legal remedies available to recover the full amount owed.
  • You will be responsible for any fees associated with collections, including legal fees.

10. Agreement to Financial Terms

10.1 Binding Agreement

This Financial Agreement constitutes a binding contract between you and Sanctifi Health PC.

10.2 Severability

If any provision of this Agreement is held to be unenforceable, the remaining provisions shall remain in full force and effect.

11. Electronic Acknowledgment and Consent

By checking the "I Agree" box, clicking "Accept," or otherwise indicating your acceptance electronically:

  1. You acknowledge that you have read, understood, and agree to all financial terms and conditions outlined in this Agreement.
  2. You understand that Sanctifi Health PC is a cash-pay only practice that does not accept insurance, Medicare, or Medicaid.
  3. You accept full financial responsibility for all services provided by Sanctifi Health PC.
  4. You acknowledge and accept the no-refund policy for all services rendered.
  5. You authorize Sanctifi Health PC to charge your payment method for services rendered in accordance with this Agreement.
  6. You agree that by engaging with Sanctifi Health PC, whether directly through our website or application, or through any third-party platform through which Sanctifi Health PC provides services, you are bound by the terms of this Financial Agreement.
  7. You understand that you may request a copy of this Agreement for your records at any time by contacting Sanctifi Health PC.